Management of coronary artery disease patients in Latvia compared with practice in Central-Eastern Europe and globally: Analysis of the CLARIFY registry

Ērglis, Andrejs; Mintāle, Iveta; Latkovskis, Gustavs; Balode, Inga; Jēgere, Sanda; Bajāre, Iveta; Rozenbergs, Aldis; Greenlaw, Nicola; Ferrari, Roberto; Steg, Philippe Gabriel

doi:10.1016/j.medici.2015.05.004

Cited by 6 publications

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“…Risk factors found in Austrian outpatients with stable CAD were smoking, overweight, hypertension, raised LDL cholesterol plasma levels, elevated heart rate and a low level of physical activity [ 16 , 18 ]. Anginal symptoms were more common in women than in men, which is consistent with the data of the whole CLARIFY population as well as the Euro Heart Survey [ 16 , 20 , 21 ]. It was shown that women present with angina twice as often as men [ 17 ].…”

Section: Discussionsupporting

confidence: 88%

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Management and clinical outcome of stable coronary artery disease in Austria

Lang

Badr-Eslam

Greenlaw

et al. 2017

Wien Klin Wochenschr

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SummaryBackgroundThe population of patients with established coronary artery disease (CAD) is growing because of an improvement in outcomes and survival from acute disease episodes. Nevertheless, these patients remain at high risk of cardiovascular events. Thus, CAD management is important in prevention of disease progression. The objective of this analysis was to describe disease management and clinical outcome of Austrian outpatients with stable CAD over 5 years by using data from the international CLARIFY registry.MethodsCLARIFY was an international prospective observational registry of outpatients with stable CAD, defined as prior myocardial infarction or revascularization (CABG or PCI), coronary stenosis of more than 50% by coronary angiography or chest pain with myocardial ischemia. We analyzed demographic characteristics, risk factors, treatments and clinical outcomes of 424 Austrian outpatients with established CAD who were enrolled between November 2009 and July 2010 and observed until September 2015.ResultsThe primary risk factors in Austrian outpatients with stable CAD were smoking (current smokers: 13.2%), overweight (77.1%), hypertension (78.5%), raised low-density lipoprotein (LDL) cholesterol plasma levels (81.4% ≥ 0.7 g/l or 1.8 mmol/l), elevated heart rate (≥70 bpm: 60.9% in patients with anginal symptoms) and poor physical activity (none or light activity: 63.4%). Patients received lipid-lowering drugs (predominantly statins), aspirin, beta-blockers and angiotensin-converting enzyme (ACE) inhibitors according to current recommendations. After 5 years a systolic blood pressure (SBP) < 140 mm Hg and diastolic blood pressure (DBP) < 90 mm Hg was reached in 58.5% of patients. Of the patients 70.4% had LDL cholesterol plasma levels below 1.0 g/l (2.6 mmol/l), 42.1% of smokers had stopped smoking, 42.9% of patients with anginal symptoms had a heart rate ≤60 bpm and 26.0% of diabetic patients had brought their HbA1c levels below 6.5%. Cardiovascular death, myocardial infarction or stroke occurred in 30 patients (7.1%), all-cause death in 25 cases (5.9%) and cardiovascular death in 15 cases (3.5%). Myocardial infarction was reported in 14 patients (fatal and non-fatal: 3.3%) and stroke in 8 patients (fatal and non-fatal: 1.9%), 39 patients (9.2%) underwent myocardial revascularization and 124 patients (29.2%) experienced cardiovascular hospitalization.ConclusionCharacteristics of Austrian outpatients with stable CAD corresponded to those of patients with CAD in other developed countries. Medical treatments following the recommendations of the European guidelines were prescribed in the majority of patients; however, recommended goals of life style interventions including a heart rate less than 60 bpm and general risk factor management were not achieved by a high proportion of patients. Heart rate control and life style changes remain unmet needs of cardiovascular care in Austria.

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Section: Discussionsupporting

confidence: 88%

“…In this context, the registry includes symptomatic and asymptomatic patients. The main objectives were to define contemporary patients with stable CAD, to identify discrepancies between evidence-based recommendations and practice, and to investigate long-term prognostic determinants [ 10 , 11 ].…”

Section: Introductionmentioning

confidence: 99%

Management and clinical outcome of stable coronary artery disease in Austria

Lang

Badr-Eslam

Greenlaw

et al. 2017

Wien Klin Wochenschr

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“…Local data are very important to develop country-specific management programs for CV patients [ 40 ]. However, previous largest studies on CV risk factors prevalence in Latvian population have not assessed depression and anxiety as possible risk factors [ 36 , 72 , 73 ]. Findings of this study suggest that detection and treatment of depression should be included in CV patients` management programs and future research on CV risk factors in Latvia.…”

Section: Discussionmentioning

confidence: 99%

Association of depression and anxiety with cardiovascular co-morbidity in a primary care population in Latvia: a cross-sectional study

et al. 2018

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BackgroundCardiovascular (CV) diseases (CVDs) are the leading cause of mortality worldwide. Globally, there is a growing interest in understanding and addressing modifiable psychosocial risk factors, particularly depression and anxiety, to prevent CVDs and to reduce morbidity and mortality. Despite the high premature mortality rate from CVDs in Latvia, this is the first Latvian study to examine the association of depression and anxiety with CVD morbidity in a primary care population.MethodsThis cross-sectional study was carried out in 2015 within the framework of the National Research Program BIOMEDICINE at 24 primary care facilities throughout Latvia. Consecutive adult patients during a one-week time period at each facility were invited to join the study. Assessments onsite included a 9-item Patient Health Questionnaire (PHQ-9) and a 7-item Generalized Anxiety Disorder scale (GAD-7) followed by a socio-demographic questionnaire and measurements of height, weight, waist circumference, blood pressure, and total cholesterol. The diagnostic Mini International Neuropsychiatric Interview (MINI) was conducted over the telephone within 2 weeks after the visit to the general practitioner. A multivariate model was developed using binary logistic regression.ResultsFrom the 1565 subjects (31.2% male), CVD was detected in 17.1%. Depression screening was positive (PHQ-9 ≥ 10) for 14.7%, and anxiety screening was positive (GAD-7 ≥ 10) for 10.1% of the study subjects. According to the MINI, 10.3% had current and 28.1% had lifetime depressive episode, and 16.1% had an anxiety disorder. Depression, not anxiety, was statistically significantly related to CVDs with an odds ratio (OR) of 1.52 (p = 0.04) for current depressive symptoms (PHQ-9 ≥ 10) and 2.08 (p = 0.002) for lifetime depressive episode (MINI).ConclusionsCurrent depressive symptoms (PHQ-9 ≥ 10) and a lifetime depressive episode (according to the MINI) were significantly associated with increased risk of CV morbidity. Therefore, CV patients should be screened and treated for depression to potentially improve the prognosis of CVDs. Enhanced training and integration of mental health treatment in Latvian primary care settings may improve clinical outcomes.

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“…Very relevant factors of AMI care are time for early diagnosis, the fastest reperfusion time, and the use of different types of medications (antiplatelet agents, antihypertensives, antianginal drugs, and lipid-lowering drugs) [8,9,10,11,12]. Previous surveys from some European countries estimated an enrichment in coronary care, accentuating improve of invasive diagnostics and treatment procedures, and an extensive use of varies medications [6,13,14,15,16,17]. Meanwhile, there was no observed marked improvement in short- or long-term survival among persons who had experienced AMI in Lithuania or other Baltic countries [13,18].…”

Section: Introductionmentioning

confidence: 99%

“…Meanwhile, there was no observed marked improvement in short- or long-term survival among persons who had experienced AMI in Lithuania or other Baltic countries [13,18]. The latest data of coronary care quality and mortality trends due to AMI in Central and Eastern European countries showed lack of similar data on extensive changes of acute coronary care in these countries [17,19]. According to official Lithuanian mortality statistics, every eighth death from ischemic heart disease occurs in persons of working (25–64 years) age, of whom even a quarter in working age men [1].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Survival after Acute Myocardial Infarction in Lithuania during Transitional Period (1996–2015): Data from Population-Based Kaunas Ischemic Heart Disease Register

et al. 2019

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Background and Objective: There is a lack of reliable epidemiological data on the long-term survival after acute myocardial infarction (AMI) in the Lithuanian population. The aim of the study was to evaluate the long-term (36 months) survival after AMI among persons aged 25–64 years, who had experienced AMI in four time-periods 1996, 2003–2004, 2008, and 2012. Material and Methods: The source of the data was Kaunas population-based Ischemic heart disease (IHD) register. Long-term survival after AMI (36 months) was evaluated using the Kaplan–Meier method. The survival curves significantly differed when p < 0.05. Hazard ratio for all-cause mortality and their 95% CIs, adjusted for baseline characteristics, were estimated with the Cox proportional hazards regression model. Results: The analysis of data on 36 months long-term survival among Kaunas population by sex and age groups showed that the survival rates among men and women were 83.4% and 87.6%, respectively (p < 0.05) and among 25–54 years-old and 55–64 years-old persons, 89.2% and 81.7%, respectively (p < 0.05). The rates of long-term survival of post-AMI Kaunas population were better in past periods than in first period. According to the data of the Kaplan-Meier survival analysis, long-term survival of 25 to 64-year-old post-AMI Kaunas population was without significantly difference in 1996, 2003–2004, 2008 and 2012 (Log-rank = 6.736, p = 0.081). The adjusted risk of all-cause mortality during 36 months among men and 25 to 54-year-old patients was on the average by 35% and 60% lower in 2012 than in 1996, respectively. Conclusion: It was found that 36 months survival post MI among women and younger (25–54 years) persons was significant better compared to men and older (55–64 years) persons. Long-term survival among 55 to 64-year-old post-AMI Kaunas population had a tendency to decrease during last period, while among 25–54 years old persons long-term survival was without significant changes. The results highlight the fact that AMI survivors, especially in youngest age, remain a high-risk group and reinforce the importance of primary and secondary prevention for the improvement of long-term prognosis of AMI patients.

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Management of coronary artery disease patients in Latvia compared with practice in Central-Eastern Europe and globally: Analysis of the CLARIFY registry

Abstract: Latvian CAD patients are well managed in terms of aspirin use and frequency of percutaneous coronary intervention. Control of obesity and high BP is poorer and needs further improvement.

Cited by 6 publications

References 5 publications

Management and clinical outcome of stable coronary artery disease in Austria

Management and clinical outcome of stable coronary artery disease in Austria

Association of depression and anxiety with cardiovascular co-morbidity in a primary care population in Latvia: a cross-sectional study

Long-Term Survival after Acute Myocardial Infarction in Lithuania during Transitional Period (1996–2015): Data from Population-Based Kaunas Ischemic Heart Disease Register

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